Recovery of corneal sensitivity after collagen crosslinking with and without epithelial debridement in eyes with keratoconus

Spadea, Leopoldo; Salvatore, Serena; Paroli, Maria Pia

doi:10.1016/j.jcrs.2014.06.030

Cited by 18 publications

(13 citation statements)

References 31 publications

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“…162,164–171 In a recent study comparing the recovery of corneal sensitivity following epi-off and epi-on approaches, both caused hypoesthesia, but corneal sensitivity was significantly reduced for up to 3 months after epi-off CXL and gradually returned to normal levels, while the recovery time was shorter (1 month) for eyes treated using epi-on CXL. 172 …”

Section: Correlation Of Corneal Nerve Alterations To Corneal Sensmentioning

confidence: 99%

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

2017

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In vivo confocal microscopy (IVCM) is becoming an indispensable tool for studying corneal physiology and disease. Enabling the dissection of corneal architecture at a cellular level, this technique offers fast and noninvasive in vivo imaging of the cornea with images comparable to that of ex vivo histochemical techniques. Corneal nerves bear substantial relevance to clinicians and scientists alike, given their pivotal roles in regulation of corneal sensation, maintenance of epithelial integrity, and proliferation and promotion of wound healing. Thus, IVCM offers a unique method to study corneal nerve alterations in a myriad of conditions, such as ocular and systemic diseases and following corneal surgery, without altering the tissue microenvironment. Of particular interest has been the correlation of corneal subbasal nerves to their function, which has been studied in normal eyes, contact lens wearers, and patients with keratoconus, infectious keratitis, corneal dystrophies, and neurotrophic keratopathy. Longitudinal studies have applied IVCM to investigate the effects of corneal surgery on nerves, demonstrating their regenerative capacity. IVCM is increasingly important in the diagnosis and management of systemic conditions such as peripheral diabetic neuropathy and, more recently, in ocular diseases. In this review, we outline the principles and applications of IVCM in the study of corneal nerves in various ocular and systemic diseases.

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Section: Correlation Of Corneal Nerve Alterations To Corneal Sensmentioning

confidence: 99%

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

2017

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“… 23 However, the epithelium debridement is not free from complications, where there is an increased risk of ulcers, infections, haze, scarring, infiltrates, longer recovery time, patient discomfort, and postoperative pain. 24 Thus, some effort has been put into the development of transepithelial (epithelium-on, epi-on) CXL. Since riboflavin cannot penetrate intact corneal epithelium due to its chemical properties, different strategies were studied to enhance transepithelial riboflavin penetration, such as increasing riboflavin imbibition time and new riboflavin solution formulations to facilitate its transepithelial penetration.…”

Section: Corneal CXLmentioning

confidence: 99%

Corneal stromal demarcation line after collagen cross-linking in corneal ectatic diseases: a review of the literature

Spadea¹,

Tonti²

2016

OPTH

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Collagen cross-linking (CXL) is a relatively new conservative approach for progressive corneal ectasia, which is able to strengthen corneal tissue reforming new covalent bonds. Subjective and objective results following this method seem to be promising. In recent years, newer CXL protocols have been developed to perform more effective and less invasive procedures. The increasing diffusion of CXL in the corneal ectatic disease has increased the need to have actual indices regarding the efficacy of the treatment. Evaluation of demarcation line (DL), a transition zone between the cross-linked anterior corneal stroma and the untreated posterior corneal stroma, is considered a measurement of the depth of CXL treatment into the stroma. Some evidence in the literature emphasize that DL could be a measure of effectiveness of the CXL. On the contrary, some authors believe that the “the deeper, the better” principle is rather a simplistic approach for interpreting the clinical importance of the corneal stromal DL.

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“…From a patient's perspective, keeping the epithelium is associated with less pain and discomfort and better visual function during recovery period compared to epithelium debridement before CXL. Further, corneal sensitivity was shown to recover much faster (7 days compared to 3 months) when the epithelium was not removed [23]. This is especially of concern since corneal sensitivity correlates with blinking frequency [24] and hence with lubrication of the eye, aiding in an uncomplicated recovery.…”

Section: Discussionmentioning

confidence: 99%

Under-the-Flap Crosslinking and LASIK in Early Ectasia with Hyperopic Refractive Error

El‐Khoury

Abdelmassih

Amro

et al. 2018

Journal of Ophthalmology

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Purpose To present safety, efficacy, and early results of a new combinational treatment for early corneal ectasia with hyperopic refractive error aimed to reinstate emmetropia and stabilize cornea. Method This is a retrospective case series. All surgeries were performed at the Beirut Eye Specialist Hospital, Lebanon. Surgical procedure consisted of (1) lifting flap (post-LASIK ectasia)/creation of corneal flap (keratoconus), (2) application of excimer laser ablation to correct refractive error, (3) loose repositioning of flap, (4) under-the-flap irrigation with riboflavin 0.1% dextran solution, and (5) application of UVA light. Results A total of 7 eyes (4 patients; mean age 24.25 years; all male) were included. 2 patients had early keratoconus, and 2 patients had early post-LASIK ectasia. Pretreatment vs. last postoperative follow-up visit (mean 11.25 months; range 6–15 months) UDVA (logMAR), spherical equivalent (SE) (D), astigmatism (D), and central pachymetry (µm) were 0.35 ± 0.18 vs. 0.05 ± 0.07, p=0.017; −0.81 ± 0.67 vs. −0.46 ± 0.57, p=0.078; 2.46 ± 0.53 vs. 0.68 ± 0.28, p=0.018; and 547 ± 58 vs. 536 ± 49, p=0.07, respectively. In all eyes, BCVA was 0.1 logMAR or better before and after treatment. No eye showed a decrease in BCVA. Two eyes of one patient had an epithelial ingrowth, which was removed in one case. Follow-up results showed no major complications and no progression of corneal ectasia. Conclusion Early results showed that under-the-flap CXL with excimer laser correction is an effective treatment for early hyperopic keratectasia, with the advantage of rapid recovery, postoperative corneal stability, and no epithelial healing complications. The procedure seems to bear a risk for postoperative epithelial growth into the flap interface.

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Recovery of corneal sensitivity after collagen crosslinking with and without epithelial debridement in eyes with keratoconus

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 18 publications

References 31 publications

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

Corneal stromal demarcation line after collagen cross-linking in corneal ectatic diseases: a review of the literature

Under-the-Flap Crosslinking and LASIK in Early Ectasia with Hyperopic Refractive Error

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